Tick bite: which medications should be used for treatment? - briefly
Doxycycline 100 mg taken twice daily for 10–14 days is the primary medication for early treatment of tick‑borne infections. If tetracyclines are contraindicated, amoxicillin is used, and severe cases may require intravenous ceftriaxone.
Tick bite: which medications should be used for treatment? - in detail
Tick bites require prompt assessment and, when indicated, targeted pharmacotherapy to prevent infection and mitigate symptoms. The first step is proper removal of the attached tick using fine‑point tweezers, grasping close to the skin and pulling steadily upward. After removal, the bite site should be cleaned with antiseptic; observation for the next 30 days is essential, especially if the tick was attached for more than 24 hours.
Antibiotic prophylaxis
- Doxycycline 200 mg orally, single dose, is recommended within 72 hours of removal for adult ticks of the Ixodes species in areas where the prevalence of Borrelia burgdorferi exceeds 20 %.
- For children weighing less than 45 kg, doxycycline 4.4 mg/kg (maximum 200 mg) is appropriate.
- Pregnant or lactating women should receive amoxicillin 2 g orally, single dose, as an alternative.
Treatment of confirmed Lyme disease
- Early localized infection (erythema migrans) – doxycycline 100 mg orally twice daily for 10–21 days; amoxicillin 500 mg three times daily or cefuroxime axetil 500 mg twice daily are acceptable substitutes.
- Early disseminated disease (multiple EM lesions, neurologic involvement) – doxycycline 100 mg twice daily for 14–21 days; intravenous ceftriaxone 2 g daily for 14–28 days may be required for neuroborreliosis or severe cardiac manifestations.
Other tick‑borne pathogens
- Anaplasma phagocytophilum: doxycycline 100 mg twice daily for 10–14 days.
- Babesia microti: atovaquone 750 mg plus azithromycin 500 mg orally on day 1, then atovaquone 750 mg twice daily plus azithromycin 250 mg daily for 7–10 days.
- Ehrlichia chaffeensis: doxycycline 100 mg twice daily for 7–14 days.
Adjunctive measures
- Non‑steroidal anti‑inflammatory drugs (ibuprofen 400 mg every 6 hours) for pain and inflammation.
- Antihistamines (cetirizine 10 mg daily) for pruritus.
- Tetanus booster if immunization status is uncertain and the wound is contaminated.
Contraindications and cautions
- Doxycycline is contraindicated in children under 8 years and in patients with known hypersensitivity to tetracyclines.
- Amoxicillin should be avoided in individuals with a history of severe β‑lactam allergy.
- Ceftriaxone requires renal dose adjustment in severe renal impairment.
Follow‑up
- Re‑examination at 2–4 weeks to assess resolution of erythema migrans or other symptoms.
- Serologic testing for Borrelia antibodies is recommended only after the initial presentation, not for routine screening.
Effective management hinges on timely tick removal, appropriate prophylactic antibiotic administration when risk criteria are met, and a full course of pathogen‑specific therapy for confirmed infections.